發(fā)布時(shí)間：2018-09-02 08:08

【摘要】： 目的：通過對(duì)模擬擴(kuò)大經(jīng)鼻-翼腭窩-翼管-Meckel腔入路所涉及結(jié)構(gòu)及毗鄰結(jié)構(gòu)的顯微解剖學(xué)研究,分析對(duì)侵及Meckel腔及翼管等結(jié)構(gòu)的三叉神經(jīng)鞘瘤等疾病術(shù)中入路的可行、可選性以及該手術(shù)入路的利弊。為提高經(jīng)鼻-翼腭窩入路切除鞍旁腫瘤的手術(shù)成功率和安全性提供解剖學(xué)依據(jù)。方法：對(duì)15具成年國人尸體頭顱標(biāo)本進(jìn)行模擬鼻內(nèi)鏡下沿入路分層顯微解剖,對(duì)相關(guān)解剖標(biāo)志進(jìn)行了觀察、分析、拍攝和測量。 結(jié)果：該入路分三步：進(jìn)入上頜竇、進(jìn)入翼腭窩、進(jìn)入Meckel腔。尋找蝶腭孔沿翼管追蹤翼管神經(jīng)血管束,解剖分離四方形空間(內(nèi)側(cè)為斜坡旁頸內(nèi)動(dòng)脈,外側(cè)為上頜神經(jīng),上界是外展神經(jīng),下界為頸內(nèi)動(dòng)脈巖部)可安全到達(dá)Meckel腔。鼻小柱至上頜竇口、蝶腭孔、翼管前孔距離分別為(44.08±2.61)mm、(64.83±2.42)mm、(70.43±2.94)mm；鼻小柱至上頜竇口及蝶腭孔連線與腭骨水平板夾角分別為：(38.10±2.46)°、(26.15±2.26)°；蝶腭動(dòng)脈外徑為2.06±0.41(1.91-2.21)mm.翼管動(dòng)脈外徑為1.10±0.33(0.98-1.23)mm；經(jīng)蝶鞍旁神經(jīng)血管關(guān)系由前向后分為：視柱三角(OST)、上三角區(qū)(STA)、上四邊形區(qū)(SQA)、下四邊形區(qū)(IQA)。 結(jié)論：擴(kuò)大經(jīng)鼻-翼腭窩-翼管-Meckel腔入路提供到達(dá)翼管及Meckel腔的前下內(nèi)面的安全直接入路,對(duì)處理翼管及Meckel腔病變是一種可被選擇的入路方式。
[Abstract]:Objective: To analyze the feasibility, selectivity, advantages and disadvantages of the approach for resection of the sella via the nasal-pterygopalatine fossa-pterygopalatine canal-Meckel approach in the treatment of trigeminal neurilemmoma involving the structures of the nasal-pterygopalatine fossa and pterygopalatine canal. Methods: Fifteen adult Chinese cadaveric head specimens were dissected under the simulated nasal endoscope along the approach, and the related anatomical markers were observed, analyzed, photographed and measured.
Results: The approach was divided into three steps: into the maxillary sinus, pterygopalatine fossa, and into the Meckel cavity. The distances of maxillary ostium, sphenopalatine foramen and pterygoid foramen were (44.08 (+ 2.61) mm, (64.83 (+ 2.42) mm, (70.43 (+ 2.94) mm, respectively; the angles between nasal columella and maxillary ostium, sphenopalatine foramen and palatal horizontal plate were (38.10 (+ 2.46), (26.15 (+ 2.26)degrees; the external diameter of sphenopalatine artery was 2.06 (+ 0.41) (1.91 - 2.21) mm. Mm. The parasellar nerve-vessel relationship can be divided from anterior to posterior: optic column triangle (OST), upper triangle (STA), upper quadrilateral area (SQA) and lower quadrilateral area (IQA).
Conclusion: Enlarged transnasal-pterygopalatine fossa-pterygoid canal-Meckel approach provides a safe direct approach to the anterior and inferior interior of the pterygoid canal and Meckel cavity, which is an alternative approach for the treatment of pterygoid canal and Meckel cavity lesions.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R322.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 許庚;李源;史劍波;謝民強(qiáng);劉賢;張革化;徐睿;;經(jīng)鼻內(nèi)窺鏡顱底手術(shù)的探討[J];耳鼻咽喉頭頸外科;1998年04期

2 白娟;尹金淑;彭洪;高順禹;彭振興;;翼管在內(nèi)鏡經(jīng)鼻顱底手術(shù)中的標(biāo)志作用[J];中國耳鼻咽喉頭頸外科;2008年11期

3 張秋航,郭永清,楊占泉,卜國鉉;經(jīng)鼻內(nèi)窺鏡手術(shù)在顱底外科的應(yīng)用[J];臨床耳鼻咽喉科雜志;1998年03期

4 楊衛(wèi)忠,陳陣,何曦,倪天瑞,張國良,劉才興,石松生,陳建屏;顯微手術(shù)治療巨大啞鈴型三叉神經(jīng)鞘瘤[J];中國耳鼻咽喉顱底外科雜志;1999年01期

5 許庚,彭藹璇;經(jīng)鼻內(nèi)窺鏡前顱底進(jìn)路切除腦膜瘤一例[J];中華耳鼻咽喉科雜志;1996年01期

6 徐淑軍,李新鋼,周茂德,陳騰,王磊,馮銘,李蓉輝;三叉神經(jīng)鞘瘤的手術(shù)入路探討[J];中華神經(jīng)外科雜志;2005年09期

7 黃學(xué)才;徐蔚;江基堯;;選擇性超深低溫?cái)嘌鲝?fù)蘇促進(jìn)猴腦中神經(jīng)生長因子和膠質(zhì)細(xì)胞源性神經(jīng)營養(yǎng)因子的表達(dá)(英文)[J];Neuroscience Bulletin;2008年03期

8 傅兵;趙繼宗;于蘭冰;;超聲技術(shù)在腦動(dòng)靜脈畸形中的應(yīng)用(英文)[J];Neuroscience Bulletin;2008年06期

9 孫敬武,羅其中,劉認(rèn)華,葉非常;經(jīng)鼻內(nèi)窺鏡顱底手術(shù)[J];中國微侵襲神經(jīng)外科雜志;2000年03期

10 毛青,王國強(qiáng),楊亞英,包顏明;Meckel腔的解剖與影像學(xué)表現(xiàn)[J];中國醫(yī)學(xué)影像技術(shù);2005年01期

，

本文編號(hào)：2218768